Provider Demographics
NPI:1679731319
Name:EXODUS HEALTHCARE NETWORK PLLC
Entity Type:Organization
Organization Name:EXODUS HEALTHCARE NETWORK PLLC
Other - Org Name:EXODUS HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEHNDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-250-9638
Mailing Address - Street 1:8211 W 3500 S
Mailing Address - Street 2:
Mailing Address - City:MAGNA
Mailing Address - State:UT
Mailing Address - Zip Code:84044-1851
Mailing Address - Country:US
Mailing Address - Phone:801-250-9638
Mailing Address - Fax:801-250-3204
Practice Address - Street 1:3336 SOUTH PIONEER PARKWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84120
Practice Address - Country:US
Practice Address - Phone:801-250-9638
Practice Address - Fax:801-417-0063
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXODUS HEALTHCARE NETWORK PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000057739Medicare PIN